Original title: A 14-years Experience with Aortic Endograft Infection: Managemente and Results. Reference: O.T.A. Lyons, et al. European Journal of Vascular and Endovascular Surgery 46;3:306-313
The infection of an Endoprosthesis is a rather infrequent complication, undesirable and associated with poor evolution, with little information in the literature and an unclear treatment strategy.
Traditionally, the prosthesis infection has been treated by prosthesis removal, debridement of all the infected tissue and artery reconstruction followed by long antibiotic therapy. However, such a surgery in patients that were poor candidates from the onset, reached a mortality rate of around 30% for the abdominal prosthesis and even higher for thoracic prosthesis.
This work involves a series of 22 consecutive patients (13 abdominal and 9 thoracic) with a documented prosthesis infection treated between 1998 and 2012.Of the total, 7 patients (32%) were given Endoprosthesis to treat complications of a previous conventional surgery. During the duration of the study, 7 aortoenteric fistulae post conventional surgery were treated with Endoprosthesis, 6 of which (86%) became infected. The infection occurred within an average of 5 months (0-51) from the implant, being the most important risk factors post implant septicemia, primary infectious, re-interventions and the fistulae. From those who presented devices in the abdominal aorta, 11 received aspiration puncture, 3 were not considered for invasive treatment due to their physical condition and died. The remaining 10 had the prosthesis removed (3 of these died within 30 days). In the medium term monitoring 3 more deaths occurred, 2 of which were not related to the Endoprosthesis infection. The prosthesis was not removed in any of the 9 patients with devices in the thoracic aorta.
An aspiration puncture was performed in 3, and a new prosthesis implanted due to the risk of bleeding or progress of the pseudo-aneurism in another 3. There were no deaths within 30 days but in the monitoring of the next 2 years, 7 out of 9 were dead.
Conclusion:
The removal of an infected abdominal Endoprosthesis results in high mortality and morbidity however it can be curative. The selection of candidates to the removal remains a big challenge. The conservative handling of an infected aortic Endoprosthesis can be associated with a survival rate not greater than 2 years.
Comments:
An infection in prosthesis is infrequent posing a true challenge to its solution. There is little information about this issue but all of them coincide that it gives a negative prognosis.
Many patients are not candidates for the removal; besides, the reconstructive surgery and the extra anatomic bypass also present a high morbimortality rate. The aspiration drainage reduces or prevents the septicemia but has little influence on the final result.
Contribution Dr Carlos Fava.
Interventional Cardiologist.
Favaloro Foundation. Argentina.
Dr. Carlos Fava para SOLACI.ORG
